Breast Cancer and Fertility Preservation
Steps to Protect Your Fertility From Cancer Treatment
Breast cancer is an emotionally devastating disease for many women, especially when it strikes a younger woman. More than 16,000 of the 200,000 women who are diagnosed with breast cancer each year are in their childbearing years. You may not know that breast cancer affects men as well, although in much smaller numbers than in women. Over 2,600 men were diagnosed with breast cancer in the past year.
In addition to the fear of breast cancer, along with determination to get the best treatment to survive and thrive, younger women may be concerned about how breast cancer treatment can affect your fertility. The type of cancer you have and the types of treatment prescribed will help your care team determine the best options to preserve your fertility. If a patient needs only surgery, her fertility will not be affected. Radiation may or may not have effects, and its influence is still being studied. If the cancer is more advanced, chemotherapy may be required. Most chemotherapy clearly affects fertility, and whether the effects are permanent or not depend on your age and the type of chemotherapy used.
Chemotherapy and Premature Ovarian Failure
Breast cancer patients treated with chemotherapy are at risk of developing very early menopause, or premature ovarian failure. The risk of infertility associated with cancer treatment is estimated at 40 percent to 80 percent by Livestrong Fertility Services, formerly known as Fertile Hope. Almost 80 percent of women treated with cyclophosphamide — an often-prescribed chemotherapy drug for treating breast cancer—will develop ovarian failure. This means their ovaries no longer produce eggs and their menstrual periods stop, just as happens naturally at menopause. Younger women may find that their ovarian function returns six months to a year after treatment. But women who are older or have had larger cumulative doses of chemotherapy may not regain normally functioning ovaries.
Fertility Preservation Begins Before Cancer Treatment
If you’ve been diagnosed with breast cancer, your first priority has to be survival. But if you are still in your child-bearing years and want to have a family, talk to your oncologist about preserving your fertility. The best time to do this is before beginning treatment. Again, the type of cancer you have and its extent will affect your options.
Advances in breast cancer care have improved the survival rate in young women, and many oncologists are sensitive to the need to not only preserve life but to preserve the quality of a survivor’s life. Being able to have a family is part of the quality of life for many women. So don’t hesitate to raise the issue with your oncologist and your care team, so you can plan together for the best treatment for you.
Options for Fertility Preservation
The option for building a future family with the highest success rate is undergoing IVF and freezing embryos for future implantation. Frozen embryos have success rates nearly as high as those of fresh embryos, and may enable you to have a baby after you have recovered, depending on the type of cancer you have and if your uterus is not affected by cancer or your treatment. IVF has to be done before cancer treatment begins, and requires a sperm donor, either your partner or sperm from a sperm bank. A typical IVF cycle costs about $10,000 plus the cost of testing and fertility medications. If you can delay treatment for the time required to perform an IVF cycle, this may be the best option to increase your chance of having a family post-treatment.
Egg freezing or oocyte cryopreservation is a newer treatment with less of a track record than IVF, but has recently been approved by the American Society for Reproductive Medicine (ASRM) and is no longer considered experimental. Some fertility centers are having success with IVF using frozen eggs. Advances have been made in the treatment using vitrification, or ultra-fast freezing, which improves the viability of the frozen eggs. In order to have your eggs frozen, you go through the same fertility drug regimen used in IVF, but the eggs are frozen when extracted instead of being fertilized in the lab. This may not be an option if you cannot delay treatment for the time required to perform an IVF cycle, or if you do not respond to the fertility drugs. But it may be a good option if you can take the time and you don’t have a partner or don’t want to use donor sperm.
A new, experimental technique is ovarian tissue retrieval. Tissue from the ovarian cortex, which is full of eggs, is removed and frozen before cancer treatment begins. Then the tissue is retransplanted after the patient is recovered, or eggs are extracted from the tissue and frozen for later use in fertility treatment. This procedure is still in the early stages of use, and there is little information yet about how successful it is. You may want to talk to your fertility specialist about this.
Other Options for Building a Family
Even if you are in ovarian failure and were not able to preserve embryos or eggs, you may still be able to have a baby by using donor eggs or donated embryos. If your uterus was not affected by treatment, you may be able to go through IVF with embryos from donor eggs fertilized by your partner’s sperm or with donated embryos. Sometimes when couples go through IVF more embryos are produced in the lab than are needed for their own IVF cycles. Some generous couples donate their extra frozen embryos so someone else can have the gift of bearing a baby and raising a child.
Adoption is another option which many people pursue. If you aren’t able or don’t want to have IVF treatment, adoption can give you the family you want and give the gift of love to a child who needs a home.